In my two earlier posts on the DxSummit.org site, I called for the creation of The Classification and Statistical Manual of Mental Health Concerns (CSM). In the first of my earlier posts, I pointed out in some general ways the various reasons why the CSM would be more practical and consistent with the principles of science than the Diagnosis and Statistical Manual of Mental Disorders (DSM). In my second post, I explain how the CSM addresses the following concern about the DSM:

The DSM purports to be, first and foremost, a diagnostic manual. But the DSM uses a descriptive approach that attempts to be neutral with respect to theories of the nature and cause of the various “disorders” that it describes. Therefore, referring to the DSM as a “diagnostic” manual is contrary to reason.

In today’s post, I explain how the CSM addresses the concern that the DSM promotes the simplistic notion that the experiences to which it assigns a mental disorder label are “bad” experiences.

“Mental Disorder” as Something Bad

In physical medicine there is general agreement between the doctor and the designated patient as to what is bad. If I go to my doctor and express a concern and he or she runs some test and then tells me I have a broken bone, I contracted yellow fever, I developed a cancerous tumor, or I have ingested a toxic substance, my doctor and I will almost always be in agreement that something bad has occurred. In contrast, when it comes to mental disorders there is a history of great disagreement between people about whether or not the expressed concern indicates that something bad has happened to the designated patient.

Doctors used to diagnose slaves who ran away as having a mental disorder. Did slaves who escaped to freedom believe there was something wrong with them? I don’t think so.

Many gay people preferred to view their sexual preference as a difference, rather than a mental disorder. Such denials by gay people that there was anything wrong with them led many psychiatrists to insist for many years that this was even more proof that “homosexuality” was indeed a mental disorder.

I just asked a group of people who have been provided the so-called diagnosis of Asperger syndrome how they felt about being viewed as having a mental disorder. Most told me that they despise it and view themselves as having some differences that often provide a degree of benefit.

The experience of depression may be the result of some events that are viewed as bad. At the same time, there are many narratives in which creative people, as they experience sadness, anguish and tears, find that these experiences deepen their concerns, deepen their search for understanding, and from this come valued outcomes.

Often people who are labeled as having schizophrenia believe there is nothing wrong with them but their family members disagree. And people “diagnosed” with bipolar are often ambivalent about their pattern of experiences, feeling that it is more aptly construed as an artistic temperament that opens doors to creativity while acknowledging rough periods as well. The concern model used in the CSM, in contrast to the mental disorder model used in the DSM, makes no assumptions that the underlying experience that leads to an expressed mental health concern is bad.

The problem of pathologizing human experiences was perhaps most eloquently expressed by William James over one hundred years ago (Rubin, 2000).

In The Varieties of Religious Experience, each time an experience is described by someone in pathological terms, James (1902/1961) quickly points out that whereas such terminology can suggest that the experience is all bad, it might actually lead to some valued fruits. Thus, James discusses individuals who view themselves as “healthy-minded.” These individuals believe that those who worry are “morbid-minded” and “diseased” (pp. 78-114). James responds to this name calling by stating that those referred to as morbid-minded have argued that “the world’s meaning most comes home to us when we lay them most to heart” (p. 116). After describing the argument between the so-called “healthy-minded” and the “morbid-minded,” James then states:

In our attitude, not yet abandoned, of impartial onlookers, what are we to say of this quarrel? It seems to me that we are bound to say that morbid-mindedness ranges over the wider scale of experience, and that its survey is the one that overlaps. The method of averting one’s attention from evil, and living in the light of good is splendid as long as it will work. It will work with many persons; it will work far more generally than most of us are ready to suppose; and within the sphere of its successful operation there is nothing to be said against it as a religious solution. But it breaks down importantly as soon as melancholy comes; and even though one be quite free from melancholy one’s self, there is no doubt that healthy-mindedness is inadequate as a philosophical doctrine, because the evil facts which it refuses positively to account for are a genuine portion of reality; and may after all be the best key to life’s significance, and possibly the only openers of our eyes to the deepest levels of truth. (p. 140)

Now, let’s jump from James’s day back into the present day. The first article that appears in this month’s American Psychologist is titled, “Professional Psychology in Health Care Services: A Blueprint for Education and Training.” (Health Service Psychology Collaborative, 2013). In its abstract, we are informed that an inter-organizational effort “was initiated to address mounting concerns related to education and training for the professional practice of psychology (p. 411, my emphasis).

Please note in the above quote the use of the words “address mounting concerns.” We see here that this team of professionals interested in Health Service Psychology had no need to first make up some mental disorders to help them to come up with some recommendations to improve what has been going on in their field of interest. Similarly, there is no need to pathologize human experiences for mental health practitioners to address the concerns of individuals who come to them for assistance.

With the CSM, we can address a concern that mental health clients express without first insisting something is bad or wrong with the client. Even if we were to find a biological difference that is correlated to a specific concern that is expressed by a minority of individuals, this would not make the concern a mental disorder. Republicans express some different concerns than Democrats. If the majority of Americans belong to the Democratic Party and we find a clear biological difference in the brains of Republicans when compared to most Americans, this would not mean, according to the CSM, that all Republicans have a diagnosable mental disorder. We could address their concerns just as well without first resorting to such name calling.

Conclusion

The expression of mental health concerns are tools. A hammer is a tool that can be used to drive in nails in the construction of a life-preserving shelter or to bludgeon an innocent person to death. A car is a tool that can be used to rush a child to an emergency room so that life-preserving treatment can be administered in the nick of time, or it can be used to tragically end a prom night. Similarly, mental health concerns can be used for good or evil. It is time that our profession fully recognizes this, and the creation of the CSM would help us to do just that.

Jeffrey Rubin, PhD, has taught conflict resolution at his alma mater, the University of Minnesota, as well as at other institutions including clinics, correctional facilities, and public schools. Additional professional roles over the years have included counseling and school psychology evaluations. Dr. Rubin publishes a weekly blog titled Name Calling, Insults, and Teasing: A Guide to Anger, Conflict, and Respect that features suggestions for working through conflict and supporting respectful relationships (drjeffreyrubin.wordpress.com). His professional journal publications include “William James and the Pathologizing of Human Experience” and “The Emotion of Anger: Some Conceptual and Theoretical Issues.” He has also authored several novels, including A Hero Grows in Brooklyn and Fights in the Streets, Tears in the Sand.

3 Comments Already

The film Lars and the Real Girl (2007) provides a thoughtful answer to the question of whether mental disorders are necessarily bad. The doctor who considers Lar’s delusion (he treats a life size female doll as if she were alive) is utterly brilliant.

I have been writing about this issue for 47 years, but the film makes the point much better than I ever have.

Hi Tom, Good to hear from you. I just arranged to have delivered to me the film Lars and the Real Girl. From your brief description (“…provides a thoughtful answer to the question of whether mental disorders are necessarily bad”) it sound like something I’d be very interested in. I hadn’t heard of it until I read your comment. It will take a week or too until I get to view it. In the meantime, I’m hoping you will tell us a little more about why you are so taken by it.